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October 06, 2010

Health Care Fraud Last Week: More Tax Dollars Wasted

by D. Cupples | The fraudulent billing of us taxpayers for health care costs is so widespread that one might call it a sport.

Below are merely a few of the cases that the Justice Department mentioned just over the last week. They're small-timers, but it all adds up. And it all adds to our nation's staggering, aggregate health care expenditures.

The El Centro Regional Medical Center (Imperial County, California) agreed to pay $2.2 million to settle allegations that it defrauded Medicare. The Justice Department states:

"The government alleges that the 165-bed acute care hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program. The settlement covers claims submitted by the hospital for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient “observation” basis or as emergency room visits."

Note that private contractors often try to settle False Claims Act cases because if a contractor is found guilty the contractor could be barred from getting future contracts.

Two New Orleans area doctors-- Dahlia Kirpatrick and Emmanuel Komandu pleaded guilty to conspiracy to commit health-care fraud. The Justice Department states:

"According to plea documents, Kirkpatrick began working with Komandu in or around January 2005. Komandu was the owner and operator of Alpha Medical Solutions Inc., a purported DME supplier based in Baker, La. Alpha purportedly specialized in the provision of power wheelchairs, wheelchair accessories and feeding nutrients to Medicare-eligible beneficiaries.

"According to court documents, from approximately January 2005 through February 2010, Komandu and Kirkpatrick submitted and caused the submission, on behalf of Alpha, of approximately $775,019 in fraudulent claims to the Medicare program. The majority of Alpha' s fraudulent claims were based on prescriptions for medically unnecessary DME [durable medical equipment] that were written and provided by Kirkpatrick. Kirkpatrick wrote prescriptions for medically unnecessary DME, such as power wheelchairs... and feeding nutrients. Medicare paid $302,811 to Alpha based on these fraudulent claims. "

Apparently, the good doctors' fraudlant claims were part of a five-year pattern. As I said, fraudulent billing has become a sport.

“…According to court documents, Ubani hired co-conspirators to recruit Medicare beneficiaries for the purposes of filing claims with Medicare for DME. Once Medicare beneficiary numbers were obtained by Ubani, Family Services [one of Urbani’s companies] submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided….

“Family Group [Urbani’s other company] purported to provide skilled nursing to Medicare beneficiaries. According to court documents, Ubani hired co-conspirators to recruit Medicare beneficiaries for the purposes of filing claims with Medicare for skilled nursing. Family Group then used the Medicare beneficiary numbers to submit claims to Medicare for skilled nursing that was medically unnecessary and/or not provided."

In yet another case, Sylvester Ijewere (owner of a Los Angeles durable medical equipment company) was sentenced to 46 months in prison and three years of probation. He was also ordered to pay $211,755 in restitution. The Justice Department states:

"Ijewere, the owner of Maydads Medical Supply, admitted that between June 2007 and October 2009, he conspired with others to purchase fraudulent prescriptions and medical documents which he used to submit false claims to Medicare for expensive, high-end power wheelchairs, and other DME. Ijewere received approximately $4,000 in reimbursement payments for each power wheelchair claim he submitted to Medicare....

"As a result of this scheme, Ijewere admitted that he submitted or caused the submission of approximately $471,345 in false and fraudulent claims to Medicare through Maydads."

My question: if he caused the submission of $471,345 in false claims, why was his restitution only $211,755?

Apprenlty, Mr. Ijewere had a co-conspirator: Donna Wells, a patient recruiter. She's going to trial in November. Maybe the DoJ plans to get restituion from Ms. Wells, too.

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